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FQR OFFICE U%_, 1 � ---------------------`- �--- ___________________ --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -.-Ix-lP-. (Complete in Duplicate) t-------- ... This Permit. Expires 1 Year From Date Issued Date'lssued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County O dinance No. 549. JOB ADDRESS P�r6 LOCATI N'_! 'r — --- -----•-••---------------------------------------- iOwner's Name 1 �r-- =--------------- --- -- ------ qG------ (rod.. Phone-----••--••-------- i Address.-.-- ' ------------------------ ---------------------------------..--- ---------------------------------------- IContractor's Name-----£ �-- ----------------------------------------------------------------------------...----- -: Phone--------------------------------------- Installation .•---------•_.....----• ---- --Installation will serve: Residence ®Apartment House F] Commercial ❑ Trailer Court ❑ pMo7el'❑ Other ❑ Number of living units: ___!___ Number of bedrooms ..3__ Number of baths J__- .Lot size ____f�--. - -.3.��------------------------ Water Supply: Public system ❑., Community system ❑ Privateepth to Water Table t. Character of soil to a depth of 3 feet: • Sand ❑ Gravel ❑ .. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-----------_--- ---.1 .NoJE]'_' New Construction: Yes [� ❑ FHA/VA: Yes I[] No 25-- TYPE OF INSTALLATION AND SPECIFICATIONS: .A ;I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! Septic T nk: Distance from nearest well_` _Distance from foundation�f�_-_ ________-Material__(-_�.�� -� • . - No. of compartments-- -_-- Size----- --:X� _ .---Liquid depth---- ........ -----.Capacity---- Disposal Field: Distance from nearest well__"---_---..Distance from foundafi nJO______________Distance to nearest lot lit(___+�-_~____ w Number of lines__.. Length of each line___.____'-.______:..__.Width of trench--Z--______________________ Type of filter material__ _ �_ _ Depth of filter material-/$---------------Total length____IrQ_____________________________ 6 See pa Pit- Distance to nearest well•....._�._._______Distan from foundation___�d__�_.-----Distance to nearest lot line-16— Number ine ] Number of, pits----------------Lining material1�9_C.-t------Size: Diameter 0-3.2-_c---------Depth------- f_-___._ Cesspool. Distance from nearest well-----------------Distance from foundation---_----------------Lining material-._..__.._____________-_--_________- ❑ Size: Diameter-.-.-------------------------------- Depth------------------ --------------- -----------------Liquid Capacity---------------- gals. . Privy: Distance from rearest well-------------------------------------------------Distance from nearest O ❑ Distance to nearest lot line_------------------- Remodeling and/or repairing (describe): ________ ______. l__- _. .___._ - ----- --------------- ------- -------------------------------------- ` _-------- _- .2 �-vle ----------- ----------------------------- I3 - ---------------------- r -------- ------------_______________________________________________•...._ _______.._____________.___»--___________.______________--________________-____________________________________.__-._______._________________-__--_----.____ I hereby certify that I have prep d thi application nd.that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an egul tons of the n Joaquin Local Health District.,, (Signed)------------------------------------------ --'--- - --------------=--- - --------- - ---------------------------------------------------- ------------- -----(Owner and/or Contractor) f By:--------------------- -------- -------------------------------------------------------------(Title)------------------- -------------------- - - - ----------- -- (Plot plan r showing s e o ton of system n relation to.wells, buildings, etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---- -----------------------=--- 41 DATE REVIEWEDBY --------- --------------------- --------------------------------------------------- DATE------------------ BUILDING PERMIT ISSUE D--------------------------------------------------------------Z-------------.------------------------- DATE--------------------- Alterations and/or recommendations----------- ------------------------------------ ---------------------------_---------- ------------------------------------------•-----------------------•-------- -----------•-------------------------------:--------------- -------------- ------------------- ---------------------------------------------------------------------------------- ---------------------------- pr . '- -J� A FINAL INSPECTION BY: ---dAQUIN -----!------------- Date--------------SAN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street r y 205 West 9rtr Street Stockton,California Lodir California Manteca,California Tracy, California ES 9 REVISED 8-54 3M 3-•63 F.P.Cq. f